Diabetes [DKA/HHS Final Exam Questions]

Diabetes [DKA/HHS Final Exam Questions] 1. A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA) secondary to A. excess insulin administration. B. inadequate food intake. C. physiologic and psychologic stress. D. increased release of antidiuretic hormone (ADH). ANS C physiologic and psychologic stress. Major neurologic and endocrine changes occur when an individual is confronted with physiologic stress caused by any critical illness, sepsis, trauma, major surgery, or underlying cardiovascular disease. 2. The hallmark of hyperglycemic hyperosmolar syndrome (HHS) is A. hyperglycemia with low serum osmolality. B. severe hyperglycemia with minimal or absent ketosis. C. little or n o ketosis in serum with rapidly escalating ketonuria. D. hyperglycemia and ketosis. ANS B severe hyperglycemia with minimal or absent ketosis. The hallmarks of HHS are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis. The disorder occurs mainly in patients with type II diabetes. 3. The primary intervention for hyperglycemic hyperosmol ar syndrome (HHS) is A. rapid rehydration. B. monitoring vital signs. C. high -dose intravenous (IV) insulin. D. hourly urine sugar and acetone testing. ANS A rapid rehydration. The goals of medical management are rapid rehydration, insulin replacement, an d correction of electrolyte abnormalities, specifically potassium replacement. The underlying stimulus of HHS must be discovered and treated. The same basic principles used to treat patients with diabetic ketoacidosis are used for patients with HHS. 4. Cha racteristics of diabetes insipidus (DI) are A. hyperglycemia and hyperosmolarity. B. hyperglycemia and peripheral edema. C. intense thirst and passage of excessively large quantities of dilute urine. D. peripheral edema and pulmonary crackles. ANS C intens e thirst and passage of excessively large quantities of dilute urine. The clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine. 5. Patients with central DI are treated with A. vasopressin. B. insulin. C. glucagon. D. propylthiouracil. ANS A vasopressin. Patients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP). DDAVP can be given intravenously , subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours. 6. In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is A. massive diuresis, leading to hemoconcen tration. B. dilutional hyponatremia, reducing sodium concentration to critically low levels. C. hypokalemia from massive diuresis. D. serum osmolality greater than 350 mOsm/kg. ANS B dilutional hyponatremia, reducing sodium concentration to critically low levels. Patients with SIADH have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. 7. Which of the following nursing interventions should be initiated on all patients with SIADH? A. Placing the patient on an air mattress B. Forcing fluids C. Initiating seizure precautions D. Applying soft restraints ANS C Initiating seizure pr ecautions The patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death. 8. A patient has a 10 -year history of diabetes mellitus. The patient is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA). Which of the following symptoms is most suggestive of DKA? A. Irritability B. Excessive thirst C. Rapid weight gain D. Periph eral edema ANS B Excessive thirst DKA has a predictable clinical presentation. It is usually preceded by patient complaints of malaise, headache, polyuria (excessive urination), polydipsia (excessive thirst), and